Thomas Szasz has left the building

Szasz is usually associated with anti-psychiatry but he rejected the label and really had nothing in common with the likes of R.D Laing, David Cooper and the rest. You can see this in his work.

He had two main arguments. The first was that the concept of ‘mental illness’ was really just a metaphor, in the same way that saying someone’s movie preferences were ‘sick’.

Because neither can be defined objectively and are a subjective interpretation of conscious states or behaviour, he excluded them from what can acceptably be called an illness.

The second stemmed from a political position. Szasz strictly adhered to a libertarian or classical liberal view of freedom and believed the only legitimate restriction of freedom should be the result of crime.

He saw psychiatry as a structure fundamentally built around restricting the freedom of ‘patients’ – the only branch of medicine to do so – meaning he thought it lacked legitimacy in both its aims and justification.

Most critics of psychiatry suggest that it doesn’t sufficiently ‘help’ people with psychological problems. Szasz saw this as promoting the idea of privileged helpers and medically-dependent patients.

Suggestions that psychiatry should not use drugs, should reject diagnoses, or should recognise some experiences as normal were an anathema to Szasz. The problem, according to him, was not the practices but a paradigm that allowed any restriction of freedom.

He was one of the most important critics of psychiatry not because he said it was done badly, but because he said it was incompatible with human liberty. A powerful reminder to a powerful profession.

But so much of it relied on buying into Szasz’s politics – and this was his major failing.

Szasz saw individual liberty as a pure and unalienable right while most see it as as important principle that should be balanced with the good of the community.

Different people draw the line in different places while Szasz is clearly on the extreme end of the spectrum.

He became famous with his bookThe Myth of Mental Illness in the 1960s when the extremes of personal freedom were popular, but as time has moved on Szasz’s politics have seemed increasingly out-of-place.

His association with Scientology through the CCHR or the ‘Citizens Commission on Human Rights’ made him look increasingly suspect as the organization lost its 60s counter-culture associations and became an intimidating corporate nonsense shop.

Szasz will surely be missed, however. He was active and writing right until the end of his life – never giving up on his campaign for extreme liberty.

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22 thoughts on “Thomas Szasz has left the building”

Szasz saw individual liberty as a pure and unalienable right while most see it as as important principle that should be balanced with the good of the community

Well, is that right, and Szasz wrong, because that sounds dangerously like a utilitarian argument, whereas saying that being suspected or convicted of crime should be the only basis for deprivation of liberty does not lead to the absurdities of utilitarianism?

If ‘the good of the community’ had felt that it needed protecting from the counter-cultural threat of the punk era, then the locking-up of punks – even those who did not commit petty crime – would have been justified. Protests and marches and those caught up in them show that the law, policing and restraint and problematic.

On this summary’s own thesis, Szasz objected to denial of liberty when it related to health, not crime: someone on section under the Mental Health Act 1983 cannot, even with capacity, object to treatment for the mental-health condition. (Compare that with consent to treatment for a physical-health condition by both someone on section, and someone else.)

Bear in mind, also, that, if the community had its way, the abolition of the death-penalty would be overturned: far more people than not believe in it, but MPs restrain its reintroduction in the absence of any campaign.

And, if my messy garden upsets my neighbours, they should also have the right to force me to care for it so that their ‘good’ prevails?

You write: “as time has moved on Szasz’s politics have seemed increasingly out-of-place.” I guess you, understandably enough, haven’t been paying much attention to US politics lately, with the revival of Ayn Rand and her arch-disciples, Congressman Ron (and his son, Senator Rand) Paul. Szasz, raised in the communist world that he vehemently rejected, seems to have had more in common with the likes of Ayn Rand than with R.D. Laing, et al.

Szasz has been frequently misinterpreted, e.g., he does not say that conditions of suffering the culture calls “mental illness” do not exist, or that psychoactive drugs cannot or should not help people. He simply objects to any and all coercion, which too frequently psychiatry employs, and he expects precise physical lesions when talking about “mental illnesses” as real “diseases”. When such lesions are actually found in medicine, e.g., syphilis, the symptoms cease being called “mental illnesses” and stop being handled by psychiatrists, which almost proves his point. He also rails against the illogic that since a drug helped someone, it necessarily proves a disease or chemical imbalance existed. No, it simply means a drug helped someone, just like caffeine does — is coffee drinking proof of caffeine deficiency disease? Prescribing psychiatric drugs is an art just as much as there’s any science involved in it. Why then should this be state-regulated, with monopoly power to prescribe psychoactive drugs being given only to state-licensed psychiatrists, who no doubt serve state interests as much if not more than patient interests? And since they serve state interests, does this not inevitably lead to coercion, such as the recent case of Brandon Raub being forcibly hospitalized by the state for his political Facebook postings ( http://tinyurl.com/8ch9gm5 )?

Never in my life have I read or seen a more stronger advocate against coercion in general, than Thomas S. Szasz.

And yet, christo22, the US is sliding into fascism with the help of those same politicians, whose real motives seem to be to assure their OWN freedom at the expense of everyone else’s. The opposite of the good of the community is not pure liberty, but, rather, the total subjugation of the community.

And,
and,
and not but,
there is much you didn’t say, and has been said by Apsley, Christo, Lee and Michael, I agree with all four.

You say ‘ his political failing’ and such it was, because if politics is ‘the art of the possible’, it was not possible for Szasz to succeed in his project.

I still feel that Vaughn’s piece was balanced and brilliant, even after reading the others’ comments and agreeing with them.

Where Vaughn differs from his 4 critics is that he lives in a political world, a world in which Szasz can be discounted because he failed, because he was demanding something that was not politically possible or rather is thought not to be by Vaughn and others. MLK’s demands, for example, used to be just as ‘impossible’.

Personal story, you can skip to the end bit, if you don’t want to read it all, by looking for

I have just been invited to speak at a conference in the US. This is a problem.

You see I swore that I would not go to the US while Bush was in power, partly as a pathetic pointless protest and partly, probably mainly, because I just can’t handle those sorts of security situations. Maybe I have a illness: bagsearchophobia?

I’m not just saying this for effect: I was a moderately successful and very minor writer and consultant in the early noughties, and I could’ve easily blagged a US gig or two, fee and all expenses – I’ve always wanted to go, still do.

I naively thought that Obama would roll back some of the excesses of TSA and the spooks, but he didn’t, and meanwhile my opportunities came and went. Or so I thought, because out of the blue, last month I was invited to a ‘3rd world development conference’ [or whatever the PC term is for it] a few weeks ago.

And I don’t now have a current passport, having resigned myself to not going abroad ever again because of the intolerable (by me) airport ‘security theatre’, on top of the intolerable process of getting a new passport. Renewing my driving license 2 years ago was bad enough – the rules for acceptable photos run to two paragraphs, including ‘no glasses’. Even I have difficulty recognising myself in the photo, sans specs, and now that I have grown a beard I live in fear of being accused of having stolen my own license if I am ever stopped by the law.

So far so mundane, suck it up, Arthur, get on with life. Either go to the conference, or don’t, either get the passport, stand in line, let them poke a sniffer dog up your rectum, or don’t. It’s 2012., all part of the real world, that Vaughn has chosen to ignore or endure, as he builds his career, carries out his work, whatever.

I last flew about 5 years ago, going to give a keynote at another conference, on an internal flight from one part of the British Isles (Nottingham in the ‘Midlands’ (the Scots don’t see Nottingham as Midlands, only the English, hence the quote marks) to another part of the UK, namely Inverness in Scotland, a matter of a few hundred miles further North in the same bloody country.

At the airport I had to go through all the crappy security theatre that I might if I was travelling to the US, but for an internal domestic flight, from one non-target area to another (if it had been Aberdeen you could possibly claim that as a target, because of the oil industry). At one point an absurd angry uniformed airport man shouted at us, after another unangry man had told us we could go through to the next room and en masse we all started to make our way across this vast empty warehouse-like space. The space could have held easily 40 times as many people, there were only about 100 of us – so people made a beeline for the exit, lifting up those elastic fence things that they have in post offices to control queues, and ducking under them. (We’d been penned up in line for a couple of hours.) Others just walked out of the ‘pen’ area into the large open space, going around rather than under the ‘fence’. In doing the ducking under several of the poles supporting the elastic fence got accidentally knocked over, making a loud clatter in the huge space. Oops.

I’m not going to tell you what happened next just yet, sorry, because I want to also mention that, as you’d expect, we were searched and required to remove our jackets. All of us, no exceptions. And that had a sad, pathetic consequence for one person, who I happened to be standing right behind.

I noticed that the young family in front of me was very upset, as a uniformed duo were insisting to mum that she remove her ‘jacket’.

( I should explain, in case you want to try to fly a ‘lack of communication’ different cuture PC kite at this point, that all the people in this part of my story were white, with English as their first language [and no detectable mental or physical impairments] as you would expect on an internal flight from the Midlands to Scotland. And out of the rest of the 100 people there I think I noticed only one or two brown or black faces, and all the staff were white, I assume local Nottingham folk. )

She tried to explain that she had nothing else on under it (clearly meaning as we all would, ‘I have underwear only’, in her case as a woman, that implied a vest or bra). They continued to insist, ignoring her words.

Now I know it was a bra, because I and all of those of us close to her were all able to see it. Because, crying, as she did so, in front of her husband -angry, controlled, seething, and her little kids -crying and let’s not forget, me and a hundred other complete strangers, she removed her jacket which was actually her top BECAUSE SHE HAD NOTHING ELSE ON, and stood there in her bra, crying, having got her tits out for the airport.

I hope you might share my anger.

You are probably asking – why wasn’t she taken to a private room and forced to remove it in the private room with only female staff present? I don’t know why not. I’m telling you what I witnessed.

But, or rather and, as this was happening something lovely and human – specifically ‘humans in the mass’ – started to happen.

As she started to remove the ‘jacket’:

(Which was of course her ‘top’, her ‘top’ being a ‘jacket’ functioning as a top, because that is the crazy world of women’s fashion, is it not – she was exhibiting that women’s fashion of wearing only a bra under a teeny tight fitting jacket in bobbly bright blue wool that showed cleavage and tummy over her tight jeans. A yummy mum going on holiday. (This is a fashion that goes back 30 years I reckon, probably started by Madonna, so no excuse Airport Nazis, for not knowing that).

I, who was closest to her, as soon as I realised she WAS actually removing it, having been distracted by her tears and those of her kids, I, as I caught a glimpse of bra strap and immediately looked away, averting my glance for it would be unseemly, found myself turning further away, and further, until I had ostentatiously turned my back, so that I was totally not looking at her breasts. (That’s not the lovely human thing, that’s just normal male behaviour.)

So, there I was, back turned to her, and this IS the point: AS WAS EVERYONE else around her: all the folk in her immediate neighbourhood, we’re busying ourselves until, in the space of a few seconds, she, and her family (and Mr and Miss Nazi), are surrounded by by a tightly packed enclosure of fellow humans, backs turned, all looking out impassively over the heads of those around them, into the middle distance.

A self-organising human cubicle!

I love the human race, I quite like religions. I hate the organised churches of all religions and, I suppose I suffer from ODD, like Brandon Raub.

I don’t like wheelchair ramps, either. Wheelchair ramps seem say to me ‘we have provided this ramp because we care about this person in a wheelchair, and by extension all the other ‘disableds’*, unlike you able-bodied passers-by who are, erm passing-by, rather than helping this ‘disabled’ by lifting their chair over these 3 steps.’

It’s tokenism, because most disableds aren’t wheelchair users, and most buildings with ramps don’t have, for example, induction loop systems for the deaf, who are a far bigger percentage of disabled than wheelchair users.

I hate it because it is theatre – it is not real, it is not human, it is false – and I therefore hate this theatre wherever I encounter it (except of course in ‘the theatre’ or on television, where it belongs).

(*perjorative term used ironically.)

So anyway, that was, I told myself, my last encounter with what Bruce Schneir, security expert and harshest critic of TSA, calls The Security Theatre’.

(Psychologist Bruce Levine, commenting on Raub, follow Lee’s link) “In my career as a psychologist, I have talked with hundreds of people previously diagnosed by other professionals with oppositional defiant disorder, attention deficit hyperactive disorder, anxiety disorder and other psychiatric illnesses, and I am struck by how many of those diagnosed are essentially anti-authoritarians, and how those professionals who have diagnosed them are not.”

Maybe it’s not me, maybe it’s them?

Ooops, nearly forgot the rest of my story:

The angry man rushed across the space towards us, face red, shouting that if we didn’t go properly around the labyrinth of poles and elastic he would “make us all come back and go through them again from the start”. I think he used some jargon – something like ‘the designated passenger queuing area’ – they love their jargon – or some such. In passing I should mention that there were no posters or signage or anything in this area to designate his clearly undesignated area – it was a uniquely empty space, like an abandoned warehouse in a early J.G.Ballard novel – there weren’t even any chairs for the elderly, infirm or families with babies.

I haven’t been spoken to like that since school. I said as much to a bloke nearby, who smiled weakly and ignored me as we all rushed for the exit, all ignoring the angry shouty man as he shouted at our backs.

J.B.Priestley warned of what he saw as the real danger should the Nazis conquer us. It was not their SS or their troops or their general or even mad Hitler, it was the legions of British pettifogging bureaucrats who would, eyes gleaming, take every opportunity to carry out to excess the bureaucratic work of the invaders. The spectre of the railway ticket inspector (armed with a Luger if they had won the war), the jobsworths, the elfansafety bloke, the implacable traffic warden towing the car away as its owner’s wife is rushed into the hospital.

So maybe, psychiatry, Vaughn, needs to revise DSM-IV and include authoritarianism and OAD (Obsessive Appliance Disorder) alongside ODD and anti-authoritarianism.

Vaughn, your piece suffers from being publishable in the mainstream American media. In that context, it is brilliant and balanced.

In the context of the wider world, as brought to me by the quartet of unpublishables above, it is biased, partial and out-of-touch.

No matter what else one may think about Dr. Thomas Szasz and his views, if one is at all familiar with his writings — and capable of a modicum of intellectual charity and honesty (as opposed to mindlessly regurgitating the opinions of his critics) — one will agree that we have lost one of the twentieth century’s great, and most underappreciated, minds. Even those unpersuaded by his arguments, and those who hold that his influence has hurt, rather than assisted, the interests of the mentally ill, ought to be able to admit that Szasz often remained brilliant even when he was wrong. He was a master rhetorician, a riveting author, and one of the last century’s pre-eminent moral thinkers and psychiatry’s most original, articulate and cogent critic.

Until the 1980s, Szasz’s ideas (even when presented in an unsympathetic light) were a standard part of the psychology, social work and psychiatry curriculum in universities in the West. The fact that since then nearly all traces of Szasz’s influential ideas have been erased from textbooks is less a result of his views having been refuted (as his critics would have it) than it is a testimony to the supremacy of ideology over intellectual honesty. It takes rare courage, persistence and strength of character to withstand the tsunami of — often unfair and dishonest — vitriolic criticism, personal attacks and professional ostracism that Szasz had to endure in the second half of his life. The barrage of hostility and ridicule never succeeded in shutting him up.

It is true that some of Szasz’s stances (e.g. his categorical rejection of any form of socialized healthcare) stand or fall with his political values. Still, even those who (like myself) don’t share his libertarian premises can identify with his relentless defence of the humanistic and personalistic conception of human beings as (at least partly) free and responsible agents, as against the dominant, and demeaning, notion of humans as biological machines entirely described, and determined, by the laws of physics. (As Szasz himself noted, in spite his atheism, many of his views resonate more closely with those of theologians than with the crude reductivistic materialism of his colleagues.) Even today, more than five decades after “The Myth of Mental Illness”, few psychiatrists, and members of the lay public, would openly object to Szasz’s insistence on viewing and treating the people we label (for the lack of a better term) mentally ill as, first and foremost, human beings, who deserve the same respect and dignity as everyone else. Yet, in the case of Szasz’s colleagues this is usually mere lip service. Modern psychiatry, with its scientistic and nihilistic thrust, trivializes and degrades its patients’ existential struggles, moral dilemmas, and emotional, social and economic difficulties by ascribing them to (yet undetectable) physiological malfunctions of the brain.

Many of Szasz’s early critics have over the years quietly come around to some of his basic views. (Karl Menninger was one of his colleagues who acknowledged his change of heart.) The notion that the great majority of people with mental illness should never be hospitalized against their will (even when they are troublesome to those around them) has become common sense. It remains one of the great injustices of history that the psychiatric establishment continues to refuse to credit Szasz with being the first member of his profession who, in the mid 1960s, stated on record — against the unanimous opinion of his colleagues — the revolutionary contention that homosexuality was not a disease, and that it didn’t warrant “treatment” of any kind.

The classical liberal notion of “live and let live” resonates closely with the “first, do no harm” of the Hippocratic Oath that Thomas Szasz took as a young medical doctor. For better or worse, Szasz remained consistently faithful to these principles of negative freedom his whole life. Those, however, who believe that, as individuals and as a society, we have a moral obligation to (somehow) assist the mentally ill even when they don’t reach out for support, would regard Szasz’s characterization of psychiatric paternalism as “cruel compassion” as equally descriptive of his own apparent lack of concern for the welfare of those labelled mentally ill. Szasz tirelessly defended the autonomy of even the most severely disturbed mental patients (so long as they didn’t violate the law), yet seemed to care little whether they live or die if no one infringed on their sacred negative rights. Although Szasz dedicated a period of his life (and a single book) to practicing his brand of psychotherapy, it was a very modest effort in comparison to the amount of time and energy he spent attacking his profession. Clearly, his hatred of institutional psychiatry dwarfed his love of its oppressed victims. (Szasz’s writings contain a number of harsh value judgments vis-a-vis the mentally ill, such as “unproductive”, “idle”, “lawless” and “bums”. Even when accurate, these are hardly dispassionately descriptive terms.) If his colleagues’ sin was overzealousness, Szasz’s was relative indifference.

Despite some common values and goals, Szasz distanced himself from the anti-psychiatry movement of the 1960s and 1970s. Unlike Ronald Laing and his associates, who stressed praxis and made efforts to understand and personally assist the mentally ill (with various degrees of success), Szasz remained a staunch theoretician, content with making attempts at changing the law in the direction of enlarging the scope of personal liberty and responsibility for the mentally ill. Whereas Laing attempted to engage with his patients’ messy humanness (with mixed results), Szasz rarely left the ivory tower from which he pontificated about his rigid absolutist principles and abstract arguments with cold, iron-clad logic (the fascinating and illuminating nature of these diatribes notwithstanding). When Szasz finally committed his thoughts on the anti-psychiatry to paper, their harshness and unfairness easily equalled that with which his own ideas had been met by the mainstream psychiatry.

It is impossible to overstate Szasz’s impact on the origin and development of the psychiatric survivor movement. Practically all the pioneers of the movement (Leonard Frank, Judy Chamberlin, David Oaks, Don Weitz, et al), regardless of their political stripes, freely acknowledge their debt to Szasz for providing them with intellectual ammunition against coercive psychiatry and spurring them to activism. Szasz was the first prominent intellectual who stressed that eccentricity and harmless social deviance were neither diseases nor crimes, and should never be treated coercively. His writings helped empower millions of readers around the world to view themselves as fully human — instead of helpless victims brain pathology — and deserving of the same basic rights as everyone else, regardless of their personal challenges. Unfortunately, some readers used Szasz’s books to rationalize their refusal to recognize that they can’t solve their problems on their own and need to seek help. Others (however few) may have tragically mistaken his unflinching notion of suicide as “a fundamental human right” for a permission to end their lives before they had exhausted all other potential options.

As he readily admitted, Szasz didn’t have superior answers as to how to best assist those overwhelmed by life’s many challenges. But he cautioned that medicalizing human existential, moral, emotional, social and economic problems only mystifies and further compounds these difficulties, leading to the “psychiatric dehumanization” of the sufferers. Today this warning is considerably more relevant then it was when Szasz articulated it half a century ago. The merger between psychiatry and the pharmaceutical industry is now nearly complete, and the arrangement is more profitable for both parties than ever before. According to the former president of the American Psychiatric Association, Dr. Stephen Sharfstein, his profession has “allowed the biopsychosocial model to become the bio-bio-bio model”. Pharmacracy is now a literal reality.

Szasz explicitly stated that his main aim has always been merely to try to think clearly. He has examined his profession’s stated values, assumptions, methods and goals with a keenly skeptical eye and peered beneath their veneer. His thought-provoking criticisms have forced his colleagues to confront their complacency: make an attempt to clarify the nature of their work, defend its scientific legitimacy and re-evaluate the ethics of their interventions. This has been a very healthy, if not particularly fruitful, exercise.

Szasz’s views have been repeatedly misunderstood by the lazy-minded and deliberately mischaracterized by opponents. It is a shame that because of systematic blacklisting his ideas are not nearly as well known as they deserve to be. Despite his critics’ charge that his arguments amount to nothing more than semantic trickery, and have been refuted decades ago, the neuropathology of mental disorders remains largely a mystery in spite of a century and half of research. The question of the ultimate nature of the experiences and behaviours classified as mental illnesses, and the best way to deal with them, is yet to be satisfactorily settled.

Dr. Thomas Szasz was one of the most brilliant, original and controversial thinkers of modern times. His iconoclastic influence on psychiatry during the latter half of the twentieth century, whether acknowledged or not, is unequalled. His intellectual legacy is a testimony to the power of healthy skepticism, fiercely independent thought and common sense. One doesn’t need to agree with any of the Hungarian-American moralist’s premises or conclusions to appreciate the depth of his analysis, the clarity of his argumentation, his riveting polemical and rhetorical skills, and his obvious passion for liberty. Szasz’s numerous books and articles will doubtless continue to inspire new generations of young people to think deeply and critically not only about psychiatry and human nature, but about all of society’s, and their own, fundamental assumptions and deeply held beliefs as well.

Thank you, Aporeticist, for that overview. You’ve noted the significance of his work more effectively than any other commentator I have seen since his death. I intend to help keep the insights, criticisms, and courage of Thomas Szasz alive by applying what I have learned from him, and speaking openly. It’s gratifying to see I am not the only one who will be doing so.

Thanks for your (too) kind words, Tracy. I value your complement all the more, having reasons to believe you strongly disagree with some of what said directly and implicitly. (Years ago we had a very brief exchange at the ThomasSzaszDiscussion Yahoo forum (I was using a different handle then). It’s a small world, indeed!🙂 ) I tried to highlight some of Szasz’s contributions and relevant facts that Dr. Vaughan Bell didn’t mention in his article. I didn’t have time to correct and edit my post; it’s just a spontaneous tribute to a man who has taught many of us so much, and whose powerful ideas ought to be rescued from undeserved obscurity.

The fact that he had not much in common with Laing, Cooper and others, is due to the fact that no matter how right is someone about something, there is not a person nor a discipline that contains all the truth, you have to look for it in different sources, he had a part of the truth, the chemical imbalance thing from psychiatry is not real, but there are some physical causes of mental disorders the he did not want to consider such as the vitamin deficiencies; not only alternative medicines but also the traditional western medicine admits that vitamin deficiencies results sometimes in physical and mental disorders (any mental disorder can be caused by that and psychiatry hides this), the hypoglucemia and the lack of nutrients in general results in depression, intoxication from heavy metals from polution that spread through the air, are absorbed by animals and vegetals, and the water that humans consume results in physical and mental disorders too, in these cases nutrition and detoxification is the solution so, he did a good job by discrediting psychiatry, but he did not criticize constructiveley since he forgot to propose and alternative to psychiatry (me, I do it).
All the same, thanks mister Szasz.

A response by somebody who is more au fait with political philosophy than science:

The problem that libertarians always run into is that there is no hard and fast definition of what is a crime and what is not.

As crime is socially constituted to a greater or lesser degree, the question of the definition of crime becomes a legitimate field of contestation by and on the part of the community and therefore the community is ultimately responsible for the setting of at least some basic ground rules of society, which need to be followed by everyone.

The libertarians I have known try and ignore this fact but it fatally undermines their whole philosophy.

What they really mean is that they would like the community to define rules which are more of preference to themselves than those currently pertaining.

It amazes me that intelligent people such as Szasz should continue to believe that the concept of “individual liberty as a pure and unalienable right” is a defensible concept to any but those who wish to live in a Mad Max style “anarchy for all” environment.

My strong suspicion is that they do in fact realise this, but fail to acknowledge it, due mainly to selfishness and arrogance.

Extreme liberty? Really? Just considering what the polar opposite of such would entail, I have my doubts. Moderate slavery versus extreme liberty? Personally, I prefer not to think of liberty as extreme, and I think Szasz, outside of the building or in, would agree with me. After all, how much slavery do we permit before it too becomes extreme?